# BLOOMINGTON ORAL SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Timothy J Devitt, DMD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841505252
- **Authorized official:** TIMOTHY DEVITT DMD (OWNER)
- **Authorized official phone:** (812) 332-2204

## Contact information

- **Practice address:** 857 S AUTO MALL RD, BLOOMINGTON, IN 47401-5447
- **Practice address phone:** (812) 332-2204
- **Practice address fax:** (821) 332-9095
- **Mailing address:** 857 S AUTO MALL RD, BLOOMINGTON, IN 47401-5447
- **Mailing address phone:** (812) 332-2204
- **Mailing address fax:** (821) 332-9095

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0652A | IN | Yes |

## Other

- **Enumeration date:** 08/10/2010
- **Last updated:** 08/10/2010